Electronic Medical Records to Improve Patient Care & Public Health in Rural Kenya

描述(由申请人提供)： 医疗保健是一个信息密集、复杂的过程。在提供者和站点之间整合医疗服务需要整合医疗信息。处于数字鸿沟另一边的发展中国家的医疗保健没有得到电子病历系统(EMRS)的充分支持。因此，无法获得数据来提高护理的质量和效率。来自印第安纳大学、Regenstrief研究所和他们在肯尼亚莫伊大学的合作者创建了撒哈拉以南非洲第一个非卧床电子病历系统，该系统服务于(现在仍然服务)肯尼亚西部的一个农村卫生中心。这一系统随后催生了在整个撒哈拉以南非洲地区的艾滋病毒/艾滋病诊所中使用的最广泛实施的全面电子病历系统：OpenMRS。虽然在肯尼亚西部，大多数艾滋病毒/艾滋病诊所都在公共卫生设施中，但也有初级保健诊所，但艾滋病毒/艾滋病信息系统没有这些初级保健诊所的数据，因此初级保健和艾滋病毒/艾滋病护理是分开进行的，没有整合。然而，这些保健中心的初级保健和艾滋病毒/艾滋病诊所都在照顾同样的病人，在获得保健总是具有挑战性的发展中国家，每次就诊都是提供以病人为中心的初级和专科护理的机会。 该项目将把最初创建OpenMRS的Mosoriot医疗记录系统重新合并到OpenMRS中。它将证明，单一的综合电子病历可以支持初级保健和艾滋病毒/艾滋病护理，并成为这两类诊所护理的有效工具。一旦整合，开发人员将证明，简单的决策支持工具，如计算机提醒，将加强对初级保健和艾滋病毒/艾滋病护理准则的遵守，例如(A)防止艾滋病毒由孕妇传播给其婴儿(具体而言，增加接受适当艾滋病毒筛查的妇女及其婴儿的人数)，(B)确保感染艾滋病毒的儿童得到适当的预防护理(具体而言，接受适当的免疫接种)，(C)协调对感染艾滋病毒和结核病的成人和儿童的护理(具体而言，增加完成适当治疗和后续工作的合并感染患者的人数)。还将衡量合并后的初级/艾滋病毒/艾滋病电子病历对提供者生产力和时间管理的影响。 为发展中国家的艾滋病毒/艾滋病护理提供资金的机构已经认识到，支付护理费用需要支付收集和管理高质量电子数据的费用。该项目将查明这些急救人员是否也能以最低限度的额外费用支持初级保健(如果能够在更大范围内证明Mosoriot卫生保健提供者生产率提高的初步证据，可能会节省费用)。如果是这样的话，只要为艾滋病毒/艾滋病护理提供资金，这种急诊护理机构将是可持续的，并且可以继续使用急救护理机构来管理和改善艾滋病毒/艾滋病和初级保健。

DESCRIPTION (provided by applicant): Health care is an information-intensive, complex set of processes. Integrating care between providers and sites requires integrating health care information. Health care in developing countries has been inadequately sup- ported with electronic medical record systems (EMRs), being on the far side of the digital divide. As a result, data are not available to enhance the quality and efficiency of care. Developers from Indiana University, the Regenstrief Institute, and their collaborators at Moi University in Kenya created sub-Saharan Africa's first ambulatory electronic medical record system that served (and still serves) a rural health centre in western Kenya. This system then gave birth to what has become the most widely implemented, comprehensive electronic medical record system used in HIV/AIDS clinics throughout sub-Saharan Africa: OpenMRS. Although in western Kenya most of the HIV/AIDS clinics are in public health facilities that also contain primary care clinics, the HIV/AIDS information system does not contain data from these primary care clinics, and therefore primary care and HIV/AIDS care happens separately, without integration. Yet both primary care and HIV/AIDS clinics in these health centres are caring for the same patients, and each visit in developing countries where access to care is always challenging is an opportunity to provide patient-focused primary and specialty care. This project will merge the Mosoriot Medical Record System, from which OpenMRS was originally created, back into OpenMRS. It will demonstrate that a single integrated EMR can support both primary and HIV/AIDS care and become an effective tool for care in both types of clinics. Once integrated, the developers will demonstrate that simple decision-support tools such as computer reminders will increase adherence to both primary care and HIV/AIDS care guidelines, such as (a) preventing transmission of HIV from pregnant mothers to their infants (specifically, increasing the number of women and their infants appropriately screened for HIV), (b) ensuring that HIV-infected children receive appropriate preventive care (specifically, receiving appropriate immunizations), and (c) coordinating care for adults and children co-infected with HIV and tuberculosis (specifically, increasing the number of co-infected patients completing appropriate treatment and follow-up). The effect of the merged primary/HIV/AIDS EMR on provider productivity and time management will also be measured. The agencies funding HIV/AIDS care in developing countries have realized that paying for care requires paying for the collection and management of high-quality electronic data. This project will discern whether such EMRs can also be used to support primary care at minimal additional cost (and perhaps be cost-saving if preliminary evidence of increased productivity of Mosoriot's health care providers can be demonstrated on a larger scale). If so, then such EMRs will be sustainable as long as HIV/AIDS care is funded, and the use of EMRs to manage and improve HIV/AIDS and primary care can be maintained.